While continuing to poke around on the HealthSystemCIO site today (thanks to the Clinical Groupware Collaborative for the pointer, BTW), I came across a very insightful piece from Dan Morreale on the possibility that stand-alone EHRs may be obsolete.

Without a doubt, EHRs play a vital role within our traditional healthcare delivery model, characterized by independent physician practices and well-defined care delivery systems. As the pace of change has accelerated, however, we have to question how well the EHR — as a stand-alone information silo lacking longitudinal context — is able to handle the demands of coordinated delivery models. It’s time to forget and rethink the model.

Essentially, the problem with existing EHRs is that they are a) hospital-centric, and b) payment-oriented.

Hospital centricity means they are targeted at the large enterprise rather than small businesses like most primary care practices and IPAs). An enterprise can impose software on their employees. A small business must have systems that their staff (especially clinicians) find useful, and most EHRs aren't especially useful to primary care providers (PCPs) in the patient encounter.

Nor were they designed to be -- I'm not roasting the EMR community for designing to the requirements of their target market. A PCP's information requirements are very different from those of the specialist or hospitalist dealing with a patient in the hospital for (in most cases) a previously diagnosed condition with a pre-existing plan of care. PCPs deal with often-nebulous complaints that may take more than one visit to pin down into a definitive diagnosis.

Moreover, care planning for the ambulatory patient, especially those with multiple serious chronic conditions, must take many more factors into account than the in-patient setting. The patient's home- and community-based informal and paraprofessional support network must be taken into account. Those traditional EHRs that capture such information, and not all do, may nonetheless fail to provide timely access to it.

Rather than requiring all eligible providers and hospitals fill out what is generally the same checklist for Meaningful Use, organizations which prove they are achieving outcomes far beyond the norm could qualify right off the bat, suggested National Coordinator for Healthcare IT David Blumenthal, M.D., at the October HIT Policy Committee meeting.

HealthSystemCIO's Anthony Guerra posted a brief report suggesting that maybe there will be different ways to meet the Meaningful Use (MU) criteria. Or maybe different criteria, I can't quite tell from his remarks.

Just what every family practitioner needs right now -- more uncertainty about HITECH! It's not surprising that a wait-and-see approach may be the path of the vast majority in the 2011 first round of MU.

We at Cielo are hard at work on activities leading to MU certification, but we are working hardest on meeting a higher standard, Meaningful Usability.

A primary care provider may find that their newfangled IT system gets in the way of delivering quality care at the same time they are purportedly documenting it. That may be Meaningful Use by HITECH standards, but it's not Meaningful Usability. We are on track to deliver a system that improves the quality of the patient encounter in addition to documenting the improvement for HITCH and other P4P/P4R purposes.

October 23, 2010

Photonic crystals are exotic materials with the ability to guide light beams through confined spaces and could be vital components of low-power computer chips that use light instead of electricity. Cost-effective ways of producing them have proved elusive, but researchers have recently been turning toward a surprising source for help: DNA molecules.

October 20, 2010

This isn't "new news", dated May 2010, but I just stumbled across it, so I thought I'd pass it along. Body Area Networks (BANs) are the newer, more intimate successor to the Personal Area Networks (PANs) that Bluetooth was going to engender. As a person approaching the age where cardiac care becomes a hot topic, I'm hoping that BANs achieve and exceed the success of the PAN concept.

Imec and Holst Centre, together with TASS software professionals have developed a mobile heart monitoring system that allows to view your electrocardiogram on an Android mobile phone. The innovation is a low-power interface that transmits signals from a wireless ECG (electrocardiogram or heart monitoring)-sensor system to an android mobile phone. With this interface, imec, Holst Centre and TASS are the first to demonstrate a complete Body Area Network (BAN) connected to a mobile phone enabling reliable long-term ambulatory monitoring of various health parameters such as cardiac performance (ECG), brain activity (EEG), muscle activity (EMG), etc.

I've already spent too much time today blogging, and need to get back to work, but I did want to pass along an idea that struck me as I read the following in a press release on a new academic research venture at the University of Southampton in the UK:

Embryonic and relatively unsophisticated examples of current human interactions with autonomous software entities include the crowd-sourcing that provides a growing element of our traffic information, user-generated content for weather reports, and our interactions with software that can find us hotels according to our preferences.

Professor Jennings says: “We are fast approaching an ‘era of ubiquity’ where each of us will become increasingly dependent on multiple smart and proactive computers that we carry with us, access at home and at work, and that are embedded into the world around us.

“This will profoundly change the ways in which we work with computers. Rather than issuing instructions to passive machines, we will increasingly work in partnership with highly inter‐connected computational components (agents) that are able to act autonomously and intelligently.”

Professor Jennings, of the School of Electronics and Computer Science at Southampton, believes that human-agent collectives – people and computational agents operating at a global scale – offer tremendous potential and, if realised correctly, will help meet key societal challenges.

However, these benefits are mirrored by the threat of equally concerning pitfalls as we shift to become increasingly reliant on systems that interweave human and computational endeavour.

The question this raised in my mind is this: Is it possible that ubiquitous computing and crowd-sourcing could be the key to informing the informal community-based support networks of chronically ill patients on how best to provide the care and support such patients urgently need?

I'm going to try to find time to explore this thought in more depth, but can't make promises: my personal and professional lives are a bit too full at the moment to commit to this!

As regular readers probably already know, I've been hiding out for several months now, getting up to speed in my new position as Chief Technology Officer at Cielo MedSolutions LLC. It's a natural next step for me, because Cielo is commercializing a University of Michigan Health System spinoff technology with which I was intimately involved in my previous position as a research informatician.

The spinoff technology was ClinfoTracker, a relatively simple and straightforward prompt and reminder system for primary care providers (PCPs). Now it has evolved into Cielo Clinic™, a clinical quality management system that can dramatically accelerate a practice's ability to participate in pay-for-performance (P4P) and pay-for-reporting (P4R) programs. Participation in P4P/R programs translates directly into additional revenue for the practice, and it does so by facilitatinbetter quality care through delivery of evidence-based medicine in situ in the PCP-patient encounter.

There are other applications that support P4P/R participation, of course; some of these also provide alerts that are crude equivalents of Cielo Clinic's prompts and reminders. By "crude"

Cielo's compelling advantage stems from its focus on capturing and using clinical data rather than relying on billing data to drive its rules engine. Rather than rely on ICD-9, the standard for coding problems in the US third-party payer world, Cielo Clinic employs ICPC and ENCODE, which are specifically designed for the primary care setting. Billing data has been shown to be unreliable for quality management in primary care.

Moreover, Cielo Clinic tracks clinician's response to the prompts. This ensures that, for example, if a physician has already advised a patient to undergo a colonoscopy based on a prompt driven by current clinical guidelines for colorectal cancer screening, and the patient refused, that prompt will not reappear for one year (or at a longer or shorter interval of the clinician's choosing, based on their knowledge of the patient).

We've been working on a new product that will soon become manifest in the marketplace, focused in part on the obvious buzzword of the day: Meaningful Use (MU), the benchmark the HITECH Act will use with its implications for direct patient care providers of $44K in incentives to adopt health IT.

However, we see HITECH and MU as blips on the strategic radar. The real opportunity -- and challenge -- in primary care health IT is in the development of Accountable Care Organizations (ACOs).

Lisa Bielamowicz, MD, Managing Director with the Health Care Advisory Board, the research division of The Advisory Board Company (ABC), recently posted a video entitled Keys to Success With Accountable Care Organizations on the MedPulse Business of Medicine newsletter from Medscape (free membership required to access). It's an 8-minute video that gives some good insights into how PCPs, their local hospitals, and the specialist practitioners with whom they collaborate can work together to improve patient care while reducing costs under the aegis of ACOs.

October 08, 2010

You can check a person’s vital signs — pulse, respiration and blood pressure — manually or by attaching sensors to the body. But a student in the Harvard-MIT Health Sciences and Technology program is working on a system that could measure these health indicators just by putting a person in front of a low-cost camera such as a laptop computer’s built-in webcam.

I found this through ACM TechNews. The technology's in a pretty raw state at this point, but it points to one facet of where we're likely to be 3-5 years down the road. Here's a YouTube video in which the inventor describes it in a nutshell. There's a link in the lower right, only barely visible, which will open the video in YouTube itself. If you slide your mouse cursor down there, you'll get hover text ("Watch on YouTube") when you're over the link.